Esophageal varices acute bleeding: Early portacaval shunt, surgical or transcutaneous
DISEASE INTERVENTION COMPARISON RESULTS
J Am Coll Surg. 2009 Jul;209(1):25-40 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, oesophageal varices The Use of
surgical emergency portacaval shunt
As Treatment, Acute
Is better Than
emergency endoscopic sclerotherapy
To permanently stop variceal bleeding (100% shunt VS 20% sclerosis), avoid future encephalopathy (15% shunt VS 35% sclerosis) and increase survival (figures?)
N Engl J Med. 2010 Jun 24;362(25):2370-9 Randomized Controlled Trial, Multicenter Study
IN gastrointestinal bleeding, upper, oesophageal varices, liver failure, liver cirrhosis, Child-Pugh class B or C The Use of
early (first 72 h) transjugular intrahepatic portosystemic shunt (TIPS), after emergency sclerotherapy
As Treatment, Acute
Is better Than
emergency endoscopic sclerotherapy plus continuation of vasoactive drugs and long-term propanolol
To reduce rebleeding at 16 months (3% TIPS Vs 44% drugs only) and increase survival at 1 year (86% TIPS Vs 61% drugs only), with no more adverse events.